Gastrectomy: What to Expect on the Day of Surgery

Gastrectomy is a surgery where part or all of the stomach is removed. It is used to treat several different conditions, including stomach cancer, obesity, and sometimes, peptic ulcers. It is major surgery that requires general anesthetic and will be done in a hospital or surgical center.

The day of surgery, many things will take place, including some that start in the morning before even leaving the house. This article will discuss the events that will occur on the day of gastrectomy surgery.

A patient receives instruction from her care team in a hospital setting.
 sturti / E+ / Getty  Images

Before the Surgery 

Some hospitals may ask patients to shower with a special type of soap prior to surgery. Instructions might also ask that patients not use any makeup, lotions, creams, or perfume after showering and before coming to the hospital for surgery.

Fasting (not eating) should have started the night before and should continue the morning of surgery. Medications the morning of surgery, including which should be taken and what the dosage should be, will have been discussed at a prior appointment. Those directions should be followed the morning of surgery. Any medications that need to be taken should be done so with a small sip of water. 

Patients will check in at the hospital or surgical center on the day of the scheduled surgery. There will be several different types of paperwork to fill out and sign. This can include intake paperwork that asks about medical history, so it will be helpful to bring a list of medications and dates or information about any other conditions or prior surgeries.

There will also be consent forms, which may include information about the surgical process and the potential for adverse outcomes. Patients (or the friend or family member that comes with the patient) should receive a copy of these forms if requested. 

Things that should be left at home the day of surgery include:

  • Contacts
  • Credit cards/money
  • Jewelry
  • Body piercings
  • Watch

Things that should be brought to the hospital the day of surgery include:

  • CPAP machine
  • Glasses
  • Hearing aids
  • Information about personal medical history
  • List of current medications

It will also be helpful to wear comfortable clothes the day of surgery.

When it’s time for the surgical intake process to start, the patient will be brought in to the pre-op area and asked to change into a hospital gown. Some hospitals will ask patients to get onto a stretcher and get comfortable.

At this point, healthcare professionals will come into the room to discuss the surgery process. The nursing staff, surgical team, and anesthesiologist will all check in, introduce themselves, ask some routine questions, and explain what’s going to happen next.

Patients may be started on an IV at this point so that medication and fluids can be given through a vein in the arm. When all is ready, it will be time to either walk or get wheeled, via a stretcher, into the operating room to start the procedure.

The anesthesiologist will then give medication through an IV so that the patient will go to sleep and remain so throughout the procedure. 

During the Surgery

After the patient has received the anesthesia through an IV and is no longer conscious, the procedure will start. Some of the actions that will take place when the patient is no longer conscious include:

  • A thin, flexible tube called a urinary catheter is placed in the urethra to collect urine (pee).
  • A nasogastric (NG) tube may be inserted through the nose and down into the stomach.
  • Compression pump boots may be put on the feet or legs in order to help prevent blood clots.
  • The abdomen (the site of the surgery) will be cleaned with an antiseptic solution.

In open surgery, an incision is made from below the breastbone down to the navel. In laparoscopic surgery, a few small incisions are made and instruments are inserted through them in order to complete the surgery. The surgeon may begin the procedure by separating the blood supply to the portion of the stomach that is going to be removed. 

When a portion of the stomach is to be removed (called a subtotal gastrectomy), that section is separated with the use of a specialized type of stapler. The stomach tissue that will remain is separated from the section that is to be taken out.

If the top portion of the stomach is removed, the remaining part will be reattached to the esophagus. If the bottom part of the stomach is removed, the remaining part will be reattached to the small intestine.

When the entire stomach is removed (called a total gastrectomy), portions of the esophagus and small intestine may also be removed at the same time. In this case, the end of the esophagus is attached to the small intestine.

For those who are receiving surgery due to a cancer diagnosis, some lymph nodes may also be removed during the surgery. 

After Surgery

When the surgery is complete, patients are wheeled into a recovery area. Depending on the way the gastrectomy was completed, patients might remain there for a few hours.

Visitors won’t usually be allowed in the recovery area. The surgeon will talk to the friends or family members who came to the hospital that day in the surgery waiting area and let them know how everything went.

In the recovery area, patients will continue to receive pain medication through an IV. There may be a pump to receive pain medication, and the patient can push a button to receive the medication. The nursing staff will continue to watch vital signs, such as blood pressure and oxygen level, as well as monitor pain levels

The surgeon or someone from the surgical staff may come in to talk about how everything went during the surgery and if there were any decisions or changes that needed to be made. 

Patients that are staying in the hospital for a few days will be transferred to a room after they are discharged from recovery. The IV will still be connected in order to continue to receive fluids and pain medication. Nurses will continue to monitor vital signs such as temperature, blood pressure, and oxygen saturation. 

An intermittent compression pump on the feet and legs may still be used at this time to prevent blood clots. The pump will inflate and deflate in order to promote blood flow and help fluid drain.

The nursing staff will give the patient more information about when it will be time to get out of bed and walk, as well as trying to eat a liquid diet or soft foods. The urinary catheter, compression pump, and nasogastric tube may be kept in place at least for the first day, and maybe a day or two longer, depending on instructions from the surgeon.

Patients will be encouraged to get out of bed and walk around as soon as they are able. This should be done frequently throughout the hospital stay in order to promote a quicker recovery and to prevent blood clots.

Patients will also be given an incentive spirometer. This is a device that helps patients to breathe more deeply and fully after surgery and helps to prevent complications in the lungs. It is a plastic device with a measuring tube and a piston and an indicator.

Patients breathe into the mouthpiece and try to get the piston and the indicator to the optimal positions. It’s usually recommended to use an incentive spirometer once an hour. The nursing staff will answer any questions and help patients understand how to use this device.    

Discharge from the hospital will take place usually after patients are able to walk and tolerate eating some food on their own. The hospital stay could be anywhere from between two and five days, but the stay could be longer in some cases.

Pain management will continue through the hospital stay and instructions will be given on how to manage pain at home before discharge. 

A Word From Verywell

Gastrectomy surgery is a major surgery that will require preparation, a hospital stay, and recovery time. Most patients do well after surgery, especially when clear instructions are given at every step of the process. Every surgeon and hospital will have slightly different ways of approaching this surgery.

In addition, the patient’s individual needs and preferences will also result in differences in how the surgery and recovery are approached. What’s important is that patients speak up about issues and concerns right away at every step of the process in order to get them addressed and solved. 

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Article Sources
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  2. Abdikarim I, Cao XY, Li SZ, Zhao YQ, Taupyk Y, Wang Q. Enhanced recovery after surgery with laparoscopic radical gastrectomy for stomach carcinomas. World J Gastroenterol. 2015;21:13339-44. doi:10.3748/wjg.v21.i47.13339. 

  3. Memorial Sloan Kettering Cancer Center. How to use your incentive spirometer. June 27, 2019

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